An article by Gavin Strang in the Observer
A grim anniversary passed this year. In 1981, the first case of Aids was officially recorded. Twenty years on, terrible epidemics rage across the globe – 36 per cent of adults in Botswana are HIV positive, 25 per cent in Zimbabwe, and Aids has orphaned more than 12 million children in sub-Saharan Africa.
Here in the UK, it is tempting to see HIV as a threat of the past. This is quite wrong. Certainly, the apocalyptic predictions of the early 1980s proved false, and the lives of people with HIV have been transformed by combination therapies.
But HIV is very much with us and the UK recorded the highest ever number of new HIV diagnoses – 3,616 – last year. We did relatively well in the early years. Public awareness was high and health agencies made major HIV prevention efforts. But complacency set in. Perhaps because of the new therapies keeping people alive, perhaps because the apocalypse did not materialise. For whatever reason, public awareness waned and HIV prevention work went off the boil.
As UNAIDS executive director Peter Piot has said, just when we know most about how to prevent HIV infection, there has been a weakening of the global effort to do something about it. Professor Peter Aggleton, in a paper published by the National Aids Trust, said that ‘almost without exception, governments in the developed world no longer see HIV prevention as a top priority, and there has been a progressive weakening of support for the provision of public information and other prevention initiatives… In Britain, prevention initiatives for the population as a whole are presently conspicuous by their absence.’
The Department of Health funding for HIV prevention has not kept up with inflation since the mid-Nineties. And until this year, funding in Scotland was frozen for several consecutive years.
There are still many people doing good work in HIV prevention. But such work has not kept up with the changing nature of the epidemic. Among gay men, the safe sex message is not getting through.
In Scotland, we could be facing a second wave of HIV. This summer, Jamie Inglis, a director at the Health Education Board for Scotland, warned that a delay in raising awareness about the dangers of unprotected sex could lead to a dramatic increase in the spread of HIV.
We must step up our HIV prevention work. Life with HIV on combination therapy is often hard. And resistance to the drugs is growing – around 20 per cent of newly infected people are infected with a resistant virus. Prevention makes hard financial sense too – the cash value of preventing one case of HIV is £500,000-£1million.
The Government’s National Strategy for Sexual Health and HIV for England is under review and there is room for progress. At present, the Government proposes abandoning its main weapon for ensuring that HIV funds are actually spent on HIV work – the ring-fenced budget. The Scottish Executive is also reviewing its ring-fenced budget for HIV prevention.
The past record of health authorities shows that the most vulnerable work would be areas such as health promotion with gay men and African communities and grants for social care. That is why I and colleagues last month urged the Government to keep the ring-fence – at least for a year or two.
HIV is very much with us. In the UK in 2001, every new case of HIV represents a failure of HIV prevention. Next Saturday is World Aids Day. By heeding the international message, we would reduce suffering in this country and set an example to help other countries with much larger epidemics.
Dr Gavin Strang is MP for Edinburgh East & Musselburgh, and was the architect of the Aids (Control) Act.
Please follow this link to see the Parliamentary debate initiated by Gavin Strang on Sexual Health on 30 October 2001.